Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database.

Background: Hospital mortality, readmission and length of stay (LOS) are commonly used measures for quality of care. We aimed to disentangle the correlations between these interrelated measures and propose a new way of combining them to evaluate the quality of hospital care.

Methods: We analyzed administrative data from the Global Comparators Project from 26 hospitals on patients discharged between 2007 and 2012.

Testing the construct validity of hospital care quality indicators: a case study on hip replacement.

Background: Quality indicators are increasingly used to measure the quality of care and compare quality across hospitals. In the Netherlands over the past few years numerous hospital quality indicators have been developed and reported. Dutch indicators are mainly based on expert consensus and face validity and little is known about their construct validity.

[Re-use of medical data for research. What do the Dutch think of the requirement for explicit consent?].

Objective: How do healthcare consumers perceive the use of medical data for scientific research, within the framework of protection of their personal data?

Design: Survey among 731 members of the Healthcare Consumer Panel of the Netherlands Institute for Health Services Research (NIVEL).

Method: A written and online questionnaire was used, consisting of general questions and 4 cases per respondent. The questions concerned the degree of trust respondents have in the use of previously registered data for different kinds of healthcare research, and their willingness to make data available under various conditions without being asked for explicit consent.

Fewer cancer reoperations for medullary thyroid cancer after initial surgery according to ATA guidelines.

Background: Surgery is still the only curative treatment for medullary thyroid cancer (MTC). We evaluated clinical outcome in patients with locoregional MTC with regard to adequacy of treatment following ATA guidelines and number of sessions to first intended curative surgery in different hospitals.

Methods: We reviewed all records of MTC patients (n = 184) treated between 1980 and 2010 in two tertiary referral centers in the Netherlands.

A combined measure of procedural volume and outcome to assess hospital quality of colorectal cancer surgery, a secondary analysis of clinical audit data.

Objective: To identify, on the basis of past performance, those hospitals that demonstrate good outcomes in sufficient numbers to make it likely that they will provide adequate quality of care in the future, using a combined measure of volume and outcome (CM-V&O). To compare this CM-V&O with measures using outcome-only (O-O) or volume-only (V-O), and verify 2010-quality of care assessment on 2011 data.

Design: Secondary analysis of clinical audit data.

Management of undescended testis: a decision analysis.

Background: Undescended testis (UDT) or cryptorchidism is the most common genital anomaly seen in boys and can be treated surgically by orchidopexy. The age at which orchidopexy should be performed is controversial for both congenital and acquired UDT.

Methods: A decision analysis is performed in which all available knowledge is combined to assess the outcomes of orchidopexy at different ages.

Influences of hospital information systems, indicator data collection and computation on reported Dutch hospital performance indicator scores.

Background: For health care performance indicators (PIs) to be reliable, data underlying the PIs are required to be complete, accurate, consistent and reproducible. Given the lack of regulation of the data-systems used in the Netherlands, and the self-report based indicator scores, one would expect heterogeneity with respect to the data collection and the ways indicators are computed. This might affect the reliability and plausibility of the nationally reported scores.

Intraoperative near-infrared fluorescence imaging of parathyroid adenomas with use of low-dose methylene blue.

Background: Intraoperative identification of parathyroid adenomas can be challenging. We hypothesized that low-doses methylene blue (MB) and near-infrared fluorescence (NIRF) imaging could be used to identify parathyroid adenomas intraoperatively.

Methods: MB was injected intravenously after exploration at a dose of 0.

Influences of definition ambiguity on hospital performance indicator scores: examples from The Netherlands.

Research Objective: Reliable and unambiguously defined performance indicators are fundamental to objective and comparable measurements of hospitals' quality of care. In two separate case studies (intensive care and breast cancer care), we investigated if differences in definition interpretation of performance indicators affected the indicator scores.

Design: Information about possible definition interpretations was obtained by a short telephone survey and a Web survey.

Successful and safe introduction of laparoscopic colorectal cancer surgery in Dutch hospitals.

Objective: To investigate the safety of laparoscopic colorectal cancer resections in a nationwide population-based study.

Background: Although laparoscopic techniques are increasingly used in colorectal cancer surgery, little is known on results outside trials. With the fast introduction of laparoscopic resection (LR), questions were raised about safety.

Surgery in adrenocortical carcinoma: Importance of national cooperation and centralized surgery.

Background: The low incidence rate of adrenocortical carcinoma (ACC) requires a multidisciplinary approach in which surgery plays an essential role because complete resection of the primary tumor is the only chance of cure. To improve patient care, insight into operative results within the ACC population is essential. In 2007, a Dutch Adrenal Network Registry was created covering care and outcome of patients treated for ACC in the Netherlands since 1965.

Risk of hypothyroidism following hemithyroidectomy: systematic review and meta-analysis of prognostic studies.

Context: The reported risk of hypothyroidism after hemithyroidectomy shows considerable heterogeneity in literature.

Objective: The aim of this systematic review and meta-analysis was to determine the overall risk of hypothyroidism, both clinical and subclinical, after hemithyroidectomy. Furthermore, we aimed to identify risk factors for postoperative hypothyroidism.

Cost-effectiveness of Internet-based self-management compared with usual care in asthma.

Background: Effectiveness of Internet-based self-management in patients with asthma has been shown, but its cost-effectiveness is unknown. We conducted a cost-effectiveness analysis of Internet-based asthma self-management compared with usual care.

Methodology And Principal Findings: Cost-effectiveness analysis alongside a randomized controlled trial, with 12 months follow-up.

Challenges and pitfalls in the management of parathyroid carcinoma: 17-year follow-up of a case and review of the literature.

A 29-year-old man presented to his primary care physician with nausea, severe weight loss and muscle weakness. He had a hard, fixed neck swelling. He was severely hypercalcaemic with 10-fold increased parathyroid hormone (PTH) concentrations.

Downregulation of CASR expression and global loss of parafibromin staining are strong negative determinants of prognosis in parathyroid carcinoma.

Parathyroid carcinoma is associated with mutations in the HRPT2/CDC73 gene and with decreased parafibromin and calcium-sensing receptor (CASR) expression, but in some cases establishing an unequivocal diagnosis remains a challenge. The aim of our study was to evaluate the prognostic value of CASR and parafibromin expression and of HRPT2/CDC73 mutations in patients with an established diagnosis of parathyroid carcinoma. Data on survival and disease-free survival were obtained from hospital records of 23 patients with an established diagnosis of parathyroid carcinoma in whom CASR and parafibromin expression and HRPT2/CDC73 mutation analyses were available from paraffin-embedded pathological specimens.

Limitations of Tc99m-MIBI-SPECT imaging scans in persistent primary hyperparathyroidism.

Background: In primary hyperparathyroidism (PHPT) the predictive value of technetium 99m sestamibi single emission computed tomography (Tc99m-MIBI-SPECT) for localizing pathological parathyroid glands before a first parathyroidectomy (PTx) is 83-100%. Data are scarce in patients undergoing reoperative parathyroidectomy for persistent hyperparathyroidism. The aim of the present study was to determine the value of Tc99m-MIBI-SPECT in localizing residual hyperactive parathyroid tissue in patients with persistent primary hyperparathyroidism (PHPT) after initial excision of one or more pathological glands.

The role of selective venous sampling in the management of persistent hyperparathyroidism revisited.

Introduction: Localization studies are mandatory prior to revision surgery in patients with persistent hyperparathyroidism in order to improve surgical outcome and reduce the risk of lengthy explorations. However, in this case, noninvasive localization studies are reported to have a poor sensitivity. The aim of our study is to determine the accuracy of selective venous sampling (SVS) for parathyroid hormone (PTH) in localizing residual hyperactive parathyroid glands in patients with persistent or recurrent hyperparathyroidism.

Choosing a hospital for surgery: the importance of information on quality of care.

Objective: To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information.

Methods: In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical procedures in 2005-2006 (aorta reconstruction [for treatment of aneurysm], cholecystectomy, colon resection, inguinal hernia repair, esophageal resection, thyroid surgery). Patients were asked which information they had used to choose this hospital and which information they intended to use if they would need similar surgical treatment in the future.

Evaluation of routinely reported surgical site infections against microbiological culture results: a tool to identify patient groups where diagnosis and treatment may be improved.

Background: Surgeons may improve their decision making by assessing the extent to which their initial clinical diagnosis of a surgical site infection (SSI) was supported by culture results. Aim of the present study was to evaluate routinely reported SSI by surgeons against microbiological culture results, to identify patient groups with lower agreement where decision making may be improved.

Methods: 701 admissions with SSI were reported by surgeons in a university medical centre in the period 1997-2005, which were retrospectively checked for microbiological culture results.

No recurrence of sporadic primary hyperparathyroidism when cure is established 6 months after parathyroidectomy.

Objective: Cure rate for primary hyperparathyroidism (PHPT) is reported to be 94-100% 1 year after surgery, but recent data suggest recurrence in 4% of the patients 1-5 years post-operatively. The aim of our study was to establish the cure rate and its maintenance in the long-term after parathyroidectomy (PTx) in patients with sporadic PHPT.

Design: Evaluation of recurrence in patients with sporadic hyperparathyroidism who underwent PTx 1-24 years prior to the study.

Internet-based self-management plus education compared with usual care in asthma: a randomized trial.

Background: The Internet may support patient self-management of chronic conditions, such as asthma.

Objective: To evaluate the effectiveness of Internet-based asthma self-management.

Design: Randomized, controlled trial.

Calcitonin and carcinoembryonic antigen doubling times as prognostic factors in medullary thyroid carcinoma: a structured meta-analysis.

Context: In the management of patients with medullary thyroid carcinoma (MTC), calcitonin doubling time (dt) has gained interest as an independent predictor of recurrence and survival.

Objective: To perform a structured meta-analysis of the diagnostic value of calcitonin dt, carcinoembryonic antigen (CEA) dt and the combination and to define dt strata with the highest predictive power. Design The study was a meta-analysis using individual data.

First the facts, then the values? Implicit normativity in evidence-based decision aids for shared decision-making.

This paper focuses on the ethics of constructing and using a specific evidence-based decision aid that aims to contribute to clinical shared decision-making processes. Results of this integrated empirical ethics study demonstrate how both the production and presentation of scientific information in an evidence-based decision-support contain implicit presuppositions and values, which pre-structure the moral environment of the shared decision-making process. As a consequence, the evidence-based decision support did not only support the decision-making process; it also transformed it in a morally significant way.

The impact of individualized evidence-based decision support on aneurysm patients' decision making, ideals of autonomy, and quality of life.

Background: Patients with an asymptomatic abdominal aneurysm and their surgeon were randomized to receive a general brochure (GB) or an IB presenting survival information and a ranking of the treatment strategies. Before and after receiving the brochure, patients filled out questionnaires on their behavior during the consultation, ideals of patient autonomy, and quality of life. Surgeons answered a short checklist evaluating the consultation.